RESUMO
Objective To evaluate the therapeutic efficiency of reversed lamellar keratoplasty for bullous keratopathy, Terrien's marginal degeneration and ocular chemical burns.Methods Twenty eyes of patients with bullous keratopathy, twelve eyes with Terrien's marginal degeneration, ten eyes with chemical burns were recruited in this study.Diseased tissues were removed by means of dissection.Reversed lamellae corneal tissues which had been prepared by cryopreservation were thawed and rinsed. Then the prepared posterior corneal lamellae was turned over, endothelium facing upwards. The diameter of the graft should be 0.5～1.0mm larger than that of the recipient bed. The reversed donor posterior lamellae was sutured into the host keratectomy bed with 10-0 nylon sutures continuously or interruptedly.Results Allograft reaction episode occurred only one (chemical burn) of the total 42 eyes enrolled.The grafts of the rest 41 eyes maintained clear or semitransparent for 1～5 years. Graft edema could be observed within 2～4 weeks postoperatively. Postoperative interface separation was not found. For all 20 patients with bullous keratopathy, the symptoms of pain disappeared. The visual acuity improved 2～3 lines of Snellen among eleven of twelve patients with Terrien's marginal degeneration. The visual acuity improved 2～3 lines of Snellen with four patients with chemical burns.Conclusion The technique of reversed lamellar keratoplasty can be applied successfully for tectonic reconstruction of corneal surface such as bullous keratopathy, Terrien' s marginal degeneration and also chemical burns.The effects of therapy was satisfactory.
RESUMO
Purpose To evaluate the clinical effects of early lamellar corneoscleral transplantation in the management of severe alkali-burned eye. Methods The patients compatible with the Ⅲ or Ⅳ grades of Roper-Hall's standards were diveded into operating group and control group according to the post-burning interval which was less than 2 weeks or more.Depending on the presence or absence of scleral nacrosis,the patients in operating group were given a lamellar corneoscleral transplantation or a lamellar keratoplasty.The patients in control group did not receive any operation.The medication was the same in the two groups. Results During the following-up of 6 to 24 months,most cases in operating group had significantly improved vision postoperatively,less inflammatory congestion,lower incidence of corneal ulcertion,and less neovasculerization.No perforation occurred in any case of the operating group.Whilst in the control group,ulcerative perforation occurred in 6 of 10 eyes,leucoma accompanied by severe panus in 6 eyes,symblepharon in 5 eyes. Conclusions Debridement with early lamellar corneoscleral transplantation can effectively decrease the occurrence of corneal perforation,prevent symblepharon,shorten the time of inflammation,and improve visual acuity.